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Action Points

Explain that researchers, calculating estimated savings over a lifetime for a cohort of individuals ages 60 to 64, predicted that Medicare could save as much as $15.1 billion, if 70% of cohort members with prediabetes or cardiovascular risk factors participated in a community-based weight loss program.

Note that a pilot program underwritten by UnitedHealth at YMCAs produced a mean 6% weight loss sustained over at least 12 to 14 months.

The financial burden on Medicare could be cut by as much as $15 billion if it funded weight-loss programs for overweight and obese people, ages 60 to 64, with certain other risk factors, researchers said.

Assuming effectiveness like that seen in a recent community-based intervention trial, in which participants had average losses of 4.2% of body weight, enrolling 70% of the 60 to 64 age cohort with "prediabetes" or cardiovascular risk factors could reduce Medicare expenditures by a net $15.1 billion over the cohort's lifetime, according to Kenneth E. Thorpe, PhD, and Zhou Yang, PhD, both of Emory University in Atlanta.

Lifetime net savings with 55% participation would be $11.9 billion, they calculated.

Writing online in Health Affairs, Thorpe and Yang noted that Medicare's recently added "wellness benefit" -- part of the Affordable Care Act -- covers an annual visit, personalized care plan, and a referral if necessary. But the new benefit doesn't include payment for commercial or community-based diet-and-exercise programs that promote better health.

"Without payment for preventive programs, the wellness benefit remains incomplete," they wrote. "We propose that Medicare expand its new wellness benefit to include reimbursement for [the modeled program] and other qualifying behavior change programs."

The Centers for Medicare and Medicaid Services actually took a step in that direction earlier this month, proposing that Medicare cover "high-intensity" obesity counseling by primary care physicians.

In a one-year trial conducted in the U.K., Germany, and Australia, much greater weight loss was seen among mainly obese participants randomized to the commercial Weight Watchers program than in those counseled in primary care.

Although weight losses in the study were not reported as percentages of initial body weight, the mean one-year loss of five pounds among patients in the primary care counseling group was almost certainly less than 4%.

For the current study's calculations, Thorpe and Yang relied on findings in the 2008 DEPLOY pilot trial of a diabetes prevention program delivered through YMCA centers.

Modeled after a program developed by the CDC, it involved group sessions delivered weekly for 16 weeks with additional follow-up meetings. It promoted intensive lifestyle modifications for both diet and physical activity.

The DEPLOY study randomized patients with elevated, but nondiabetic, fasting blood glucose levels and other risk factors to participate in the program, or to visit YMCA centers and use their regular services as participants wished.

At follow-up, those in the intervention group had a mean 6% weight loss after six months. This was 4.2 percentage points higher than in a control group receiving only standard weight loss advice, and the results were sustained for more than 12 to 14 months. These participants also lowered their total cholesterol by about 25 mg/dL.

Thorpe and Yang used other published data to estimate the effect on Medicare utilization from these improvements in risk factors if achieved broadly in the population at ages 60 to 64.

If only prediabetic individuals are targeted, the net savings with 70% participation over the cohort's lifetime would be $9.3 billion, the researchers calculated.

Focusing the program on individuals 60 to 64 with cardiovascular risk factors such as high cholesterol and family history, but with normal blood glucose, would create net lifetime savings of $5.8 billion with 70% participation.

Thorpe and Yang also calculated savings over a 10-year period starting in 2011, therefore assuming an immediate implementation.

Targeting everyone 60 to 64 with prediabetes or cardiovascular risks and achieving 70% participation, the net 10-year saving would be $3.7 billion.

The lifetime savings are four times greater because, as these individuals age, the medical costs associated with failing to prevent more serious disease accelerate.

"Our results show the potential savings to Medicare if a proven, community-based approach to reducing obesity and related chronic disease were to be made available, nationwide, to high-risk individuals soon to become Medicare beneficiaries," Thorpe and Yang wrote.

"They also present a potential business case for the federal government to partner with the private sector in order to encourage broad enrollment in effective weight loss programs," they said.

Thorpe and Yang noted that the YMCA program had been funded by the insurance company UnitedHealth, calling it "an important case in point."

If such an effort were to prove cost-effective in the 60 to 64 age group, the government should then consider extending it to both younger and older age groups, they suggested.